U.S. patent application number 11/372520 was filed with the patent office on 2007-02-15 for surgical retractor.
This patent application is currently assigned to CARDIO LIFE RESEARCH S.A.. Invention is credited to Bernard De Canniere, Michel Joie.
Application Number | 20070038032 11/372520 |
Document ID | / |
Family ID | 35335769 |
Filed Date | 2007-02-15 |
United States Patent
Application |
20070038032 |
Kind Code |
A1 |
De Canniere; Bernard ; et
al. |
February 15, 2007 |
Surgical retractor
Abstract
A Surgical retractor, designed in particular for minimally
invasive operations, consisting essentially of an elastic plate
rolled up about an axis so as to form the side wall of a
substantially truncated cone shape, the narrowest cross section of
the truncated cone constituting the distal part of this retractor,
when the retractor is in place, and delimiting an operating field,
the widest cross section of the truncated cone forming the proximal
part, through which instruments can be introduced, said plate being
able to be rolled up into a substantially cylindrical shape with a
diameter smaller than or equal to the narrowest cross section of
its truncated cone shape.
Inventors: |
De Canniere; Bernard;
(Brussels, BE) ; Joie; Michel; (Ernage,
BE) |
Correspondence
Address: |
TOWNSEND AND TOWNSEND AND CREW, LLP
TWO EMBARCADERO CENTER
EIGHTH FLOOR
SAN FRANCISCO
CA
94111-3834
US
|
Assignee: |
CARDIO LIFE RESEARCH S.A.
Louvain-la-Neuve
BE
|
Family ID: |
35335769 |
Appl. No.: |
11/372520 |
Filed: |
March 10, 2006 |
Current U.S.
Class: |
600/210 |
Current CPC
Class: |
A61B 17/3423 20130101;
A61B 17/3439 20130101; A61B 17/0293 20130101; A61B 2017/00243
20130101; A61B 18/1402 20130101; A61B 2018/00982 20130101; A61B
2017/0212 20130101; A61B 17/0218 20130101 |
Class at
Publication: |
600/210 |
International
Class: |
A61B 1/32 20060101
A61B001/32 |
Foreign Application Data
Date |
Code |
Application Number |
Aug 11, 2005 |
EP |
A-05107376.5 |
Claims
1. A Surgical retractor consisting essentially of an elastic plate
rolled up about an axis so as to form the side wall of a
substantially truncated cone shape, a narrowest cross section of
the truncated cone constituting a distal part of the retractor when
the retractor is in place and delimiting an operating field, a
widest cross section of the truncated cone forming a proximal part,
through which instruments can be introduced, said plate being able
to be rolled up into a substantially cylindrical shape with a
diameter smaller than or equal to the narrowest cross section of
its truncated cone shape.
2. A Surgical retractor according to claim 1, comprising connecting
means that are able to keep the side wall of the truncated cone
rolled up at a defined diameter.
3. A Surgical retractor according to claim 2, wherein the
connecting means comprise a button and a buttonhole.
4. A Surgical retractor according to claims 1 wherein in the
absence of stress, the elastic plate that constitutes the side wall
of the truncated cone shape spontaneously adopts a substantially
flat shape.
5. A Surgical retractor according to claims 2 wherein, in the
absence of stress, the elastic plate that constitutes the side wall
of the truncated cone shape spontaneously adopts a substantially
flat shape.
6. A Surgical retractor according to claim 1 wherein, in the
absence of stress, the elastic plate that constitutes the side wall
of the truncated cone shape spontaneously adopts a truncated cone
shape.
7. A Surgical retractor according to claim 2 wherein, in the
absence of stress, the elastic plate that constitutes the side wall
of the truncated cone shape spontaneously adopts a truncated cone
shape.
8. A Surgical retractor according to claim 1, wherein the plate has
a shape substantially in the form of a truncated crescent, the
inner curve of this crescent, in the form of an arc of a circle,
having a length corresponding to the maximum perimeter of the
narrowest cross section of the truncated cone delimiting the
operating field, two straight sides connecting the ends of these
arcs of circles and extending substantially parallel to one
another, their length corresponding to the height of the truncated
cone.
9. A Surgical retractor according to claim 1, which comprises
protuberances arranged on the wall of the truncated cone.
10. A Surgical retractor according to claim 1, characterized in
that it comprises, at the proximal end, grip means facilitating its
manipulation.
11. A Surgical retractor according to claim 10 wherein the grip
means are able to cooperate with gripper means mounted on an end of
positioning tools of elongate shape that are introduced through its
proximal part, said positioning tools allowing the plate to be
rolled up.
12. A Surgical retractor according to claim 11 wherein the
positioning tools can be secured together, with the retractor
maintained in the rolled-up position.
13. A Surgical retractor according to claim 1, wherein the plate is
transparent.
14. A Surgical retractor according to claim 2, wherein the plate is
transparent.
15. A Surgical retractor according to claim 1, wherein the proximal
end of the plate comprises fixation points for means for holding
the retractor in the course of an operation.
16. A Surgical retractor according to claim 2, wherein the proximal
end of the plate comprises fixation points for means for holding
the retractor in the course of an operation.
17. A Surgical retractor according to claim 1 wherein the outer
face of the plate comprises conductive elements that are able to be
connected to a generator so as to produce localized tissue
necrosis.
18. A Surgical retractor according to claim 13 wherein the outer
face of the plate comprises conductive elements that are able to be
connected to a generator so as to produce localized tissue
necrosis.
19. A Surgical retractor according to claim 14 wherein the outer
face of the plate comprises conductive elements that are able to be
connected to a generator so as to produce localized tissue
necrosis.
20. A method for using a surgical internal retractor comprising the
following steps: providing a plate of elastic material that is able
to adopt a substantially truncated cone shape; bringing said plate
into its truncated cone shape; gripping said plate via its end of
large diameter, which forms its proximal part, rolling said plate
up in such a way as to form a cylinder of small diameter; passing
the retractor through an incision in a body, with the distal part,
corresponding to its narrowest diameter, towards the front;
allowing the retractor to unroll in such a way that it readopts its
truncated cone shape performing an operation on an internal organ
rolling said plate up in such a way as to form a cylinder of small
diameter; extracting said cylinder through the incision.
Description
FIELD OF THE INVENTION
[0001] The invention relates to surgical retractors, in particular
to retractors used in the field of minimally invasive surgery, for
example for operations in the cardiac field.
[0002] Retractors are instruments intended to clear the operating
field by spreading apart the edges of an incision or of a natural
orifice. Thus, in conventional cardiac surgery, the operating
surgeon has a relatively wide operating field, resulting from the
fact that a sternotomy has been performed. The situation is very
different in the case of minimally invasive surgery: the access
routes are small incisions made in particular between the ribs; the
operating surgeon does not generally have a direct view of the
operating field, but instead has a view through an endoscope; the
instruments have to be operated remotely within a very small space
and are therefore very different to handle.
BACKGROUND OF THE INVENTION
[0003] Conventional retractors are known in this field which have
the form of spatulate hooks.
[0004] This type of retractor is also used in minimally invasive
surgery.
[0005] In the case of intrathoracic surgery performed without a
sternotomy, it is necessary to exert traction from the outside,
either by an operating surgeon holding the retractor via a handle,
or by fastening it to the surrounding tissues, which includes the
rib cage, or by threads passing through the rib cage.
[0006] There are also retractors that can be described as
peripheral retractors, which are used for example in eye surgery
(see U.S. Pat. No. 6,083,155).
[0007] However, this type of retractor can be used only in
operations in which there is no problem of access and in which the
operating field is not deep. Pneumatic retractors formed by an
inflatable cuff are also known from U.S. Pat. No. 5,342,385. This
type of retractor, which is of considerable size, poses problems of
deflation if torn by a cutting instrument.
[0008] Retractors specifically designed for spinal surgery are also
known from US 2004/116954 and from WO 2004/021899. These retractors
comprise, mounted at the end of a cylindrical tube, a truncated
cone part in the shape of a funnel (widening toward the distal
part). This is a relatively complex device which has to be deployed
with force. Moreover, this type of retractor does not permit direct
viewing of the operating field, and the<<keyhole>>view
produced is advantageous only if the eye of the camera is near the
incision, which is not always the case.
SUMMARY OF THE INVENTION
[0009] It has been sought to produce a rectractor of small size
which is easy to introduce into the inside of a patient's body,
requires a reduced number of steps for putting it into place, and
permits easy access and also a clear view of an operating field,
either directly or by way of an endoscope.
[0010] The subject of the invention is a surgical retractor
consisting essentially of an elastic plate rolled up about an axis
so as to form the side wall of a substantially truncated cone
shape, the narrowest cross section of the truncated cone
constituting the distal part of this retractor when the retractor
is in place, and delimiting an operating field, the widest cross
section of the truncated cone forming the proximal part, through
which instruments can be introduced. Said plate is able to be
rolled up into a substantially cylindrical shape with a diameter
smaller than or equal to the narrowest cross section of its
truncated cone shape.
[0011] The apparently very simple design of this retractor is the
result of an extensive study of the ergonomic requirements of
surgeons in the field of minimally invasive surgery. In particular,
the maneuvres required for putting it into place afford a
considerable saving in terms of time. In addition, the reduced
stress that it exerts on the wall of. the incised organs means that
it is especially indicated for operations on hollow organs such as
the heart, the intestines, etc. Moreover, even if the incision is
of a small size, the operating surgeon has, compared to the prior
art, twice the view of the operating field, that is to say by
direct viewing through the incisions combined with a view by way of
an endoscope.
[0012] According to an advantageous embodiment, the retractor
comprises connecting means that are able to keep the side wall of
the truncated cone rolled up at a defined diameter. These
connecting means can in particular comprise a button and a
buttonhole. The advantage of these elements lies in avoiding
distortion at the moment of deployment or during the course of the
operation.
[0013] According to one embodiment, in the absence of stress, the
elastic plate that constitutes the side wall of the truncated cone
shape spontaneously adopts a substantially flat shape.
[0014] According to another embodiment, in the absence of stress,
the elastic plate that constitutes the side wall of the truncated
cone shape spontaneously adopts a truncated cone shape.
[0015] The plate preferably has a shape substantially in the form
of a truncated crescent, the inner curve of this crescent, in the
form of an arc of a circle, having a length corresponding to the
maximum perimeter of the narrowest cross section of the truncated
cone, and, instead of the horns of the crescent, it comprises two
sides which are substantially parallel to one another, their length
corresponding to the height of the truncated cone.
[0016] The surgical retractor of the invention preferably comprises
protuberances arranged on the flanks of the wall of the truncated
cone.
[0017] It advantageously comprises, at the proximal end, grip means
facilitating its manipulation.
[0018] These grip means are preferably able to cooperate with
gripper means mounted on the end of positioning tools of elongate
shape, said positioning tools allowing the plate to be rolled up
and to be maintained in the rolled-up state.
[0019] According to an advantageous embodiment, these positioning
tools comprise connecting means with which it is possible to secure
them together so as to facilitate their manipulation, particularly
with the retractor maintained in the rolled-up position.
[0020] The inner face of the surgical retractor according to the
invention is preferably transparent. In this case, according to an
advantageous embodiment, the outer face of the plate comprises
conductive elements that are able to be connected to a generator so
as to produce localized tissue necrosis, such as that produced in
the elimination of atrial fibrillation.
[0021] The plate can also be made of a frosted material, which can
be metal or plastic, in order to avoid interference from
reflections during use.
[0022] The proximal end of the plate advantageously comprises
fixation points for means for holding the retractor in the course
of an operation. These holding means can, for example, be a support
formed by suture threads, etc.
BRIEF DESCRIPTION OF THE FIGURES
[0023] These features, and other features of the invention, will
become clear from the following detailed description of particular
embodiments of the invention, reference being made to the figures
in the drawings, in which:
[0024] FIG. 1 is a schematic and cut-away perspective view of a
standard intrathoracic operation performed by a minimally invasive
technique.
[0025] FIG. 2 is a perspective view of a retractor according to the
invention positioned in an atrium of the heart.
[0026] FIG. 3 is a plan view of a retractor according to the
invention spread out flat.
[0027] FIG. 4 is a plan view of another embodiment of a retractor
according to the invention spread out flat.
[0028] FIGS. 5 and 6 are perspective views of instruments for
manipulating a retractor according to the invention, keeping the
retractor respectively deployed and rolled up in a compact form for
introduction.
[0029] FIGS. 7, 8 and 9 are perspective views of the retractor from
FIG. 4 at different stages of its manipulation.
[0030] FIG. 10 is a schematic perspective view of another
embodiment of the retractor.
[0031] FIG. 11 is a schematic perspective view of the retractor
from FIG. 10 in position in an atrium.
[0032] The figures are not drawn to scale. Generally, similar
elements are designated by similar reference labels in the figures.
The present invention will be described in the context of specific
embodiments that have been chosen as non-limiting
illustrations.
DETAILED DESCRIPTION OF THE FIGURES
[0033] FIG. 1 shows the conditions in which minimally invasive
intrathoracic surgery is performed: the instruments 2 are
introduced inside the thorax via small incisions, without cutting
the ribs 3 or sternum 4.
[0034] FIG. 2 shows the retractor 6 of the invention positioned for
an operation on an atrium 8 of the heart. As the walls of the heart
10 are relatively thin and have little muscle in the area of the
atrium 8, it would be awkward to place conventional retractors
there which are anchored to the rib cage 3. As will be seen, the
retractor 6 basically comprises a plate 12, made of an elastic
material, rolled up so as to form the side wall of a truncated
cone. The distal part of this truncated cone is driven through an
incision 14 into the interior of the atrium 8. The narrowest cross
section 16 of the truncated cone thus delimits the operating field,
while the conicity of the wall provides a clear zone for movement
of the surgical instruments and for the viewing field of the
operating surgeon, which in this case corresponds to the field
covered by an endoscope 18 placed near the axis of the truncated
cone, in the area of its widest cross section 20. To maximize the
stereoscopic vision that the operating surgeon may have of the
operating field, it is important to widely retract the tissues
freed by the incision.
[0035] FIG. 3 shows one embodiment of the retractor 6. In this
embodiment, the elastic plate 12, in the absence of stress, adopts
a substantially flat shape. Its shape as a crescent, with the two
horns cut away, corresponds substantially to the side wall of a
truncated cone and comprises two sides in the shape of arcs of a
circle: an inner side 16 with a length corresponding to that of the
narrowest cross section of a truncated cone and with radius R1, and
an outer side 20 with radius R2 corresponding partially to the
circumference of the large cross section of the truncated cone. As
can be seen from FIG. 3, the large cross section 20 has part of its
circumference cut off by two substantially parallel sides 22
issuing from the ends of the side 16.
[0036] At the side corresponding to the narrowest cross section of
the truncated cone, the plate 12 is provided with connecting means
24, 26 which cooperate with one another to maintain the retractor
in the curved shape when they are engaged in one another.
[0037] As shown in FIG. 3, these connecting means are a button 24
and a buttonhole 26 with catch 28, but it goes without saying that
other embodiments (clips, snap fasteners, etc.) may be used.
Several points of connection may be provided, this making it
possible to vary the nominal diameter of the retractor depending on
the size of the organ to be operated on, or, as is shown in FIG. 4,
making it possible to extend the buttonhole so as to obtain a
variable cross section.
[0038] A series of perforations are formed along the proximal face
of the plate. They form anchoring points 29 with which it is
possible, if necessary, to tie the retractor to the surrounding
tissues.
[0039] Grip means 30, in this case openings 30, can be seen near
both ends of the side corresponding to the circumference of the
large cross section of the truncated cone. Their role will be
explained further below.
[0040] Protuberances 32, in this case arranged longitudinally,
protrude along the length of the plate. They have a secondary role
of stiffeners, but their main function is to avoid adherence of the
inner walls of the incised organ 14 against the continuous surface
of the plate 12. These protuberances can be lengthened and can form
fold lines which, if necessary, transform the operating field into
a polygonal surface.
[0041] FIG. 4 shows another embodiment of the retractor according
to the invention. In this embodiment, a very long buttonhole 27 is
used, also provided with catch means 28, permitting automatic
adaptation of the diameter to the length of the incision and to the
diameter of the distal operating field. In addition, it is thereby
possible to considerably reduce the diameter of the retractor in
the rolled-up state.
[0042] FIGS. 5 and 6 permit a better understanding of the role of
the grip means 30 and of the way in which the retractor is fitted
in place. To insert the retractor 6 inside the rib cage 3, 4, the
operating surgeon has two positioning instruments 34 of elongate
shape. Each of these instruments is provided, at its distal end,
with gripper means 36 (in this case a button-shaped head 36) that
are able to cooperate with the grip means 30 of the retractor.
[0043] By manipulating the two instruments 34, the operating
surgeon is able to roll the plate 12 up (see FIG. 4). The roll thus
formed, of small diameter, can easily be inserted into the thorax
3, 4 through an incision and positioned in the atrium 8. The
instruments 34 are specifically designed to be easily bent and
therefore adapt to different angles of intervention.
[0044] To avoid the plate 12 accidentally unrolling, and to permit
their manipulation by just one hand, the positioning tools 34 are
provided with a securing clip 38. The presence of this securing
clip 38 facilitates the work of the operating team, as the
retractor can be passed from hand to hand during the operation
without risk of its unrolling, thus saving precious time for the
surgeon and the patient.
[0045] As soon as the positioning tools 34 are disconnected, the
inherent elasticity of the plate 12 forces the retractor to open
out and adopt the required truncated cone shape.
[0046] FIGS. 7, 8 and 9 show another way of introducing the
retractor into place. Rather than using the positioning instruments
34 described above, the operating surgeon in this case uses
conventional locking tweezers (or forceps) 40.
[0047] In FIG. 7, the operating surgeon rolls the plate up and
locks the retractor in a roughly truncated cone position with the
aid of the connecting means.
[0048] In FIG. 8, the operating surgeon forces the plate to roll up
until he obtains a cylindrical roll of small diameter. He locks the
retractor in this position with the aid of locking tweezers 40. He
finally introduces the retractor into place (FIG. 9) via its distal
section.
[0049] It will be noted that the substantially flat shape of the
elastic plate 12 allows it to be stored flat, in a way that saves
space in particular, and avoids any creep in cases where the plate
is made of materials sensitive to this phenomenon. The retractor
can be made of plastic materials, such as PET or PTFE, and also of
a biocompatible metal such as stainless steel, titanium alloys,
etc.
[0050] The retractor, like the positioning instruments 34, is
offered in different standard dimensions and can either be reusable
or intended to be disposed of after one use.
[0051] The advantages associated with the flat opened-out shape do
not, however, mean that a retractor according to the present
invention cannot, in the absence of stress, have a truncated cone
shape at rest. However, even when produced in such a shape, it is
preferable to provide it with connecting means, so that the
pressure of the incised tissues does not cause distortion during
the operation.
[0052] The retractor can be made of an opaque, translucent or
transparent material. However, regardless of the material used, it
is important that the inner wall reduces as far as possible any
reflections that might disturb the operating surgeon. To this end,
this wall may be frosted.
[0053] The use of a transparent wall allows the operating surgeon
to visually monitor the state of the wall. The surgical procedures
are often combination procedures, and several maneuvres are often
performed in succession. The repair of a mitral valve is also often
accompanied by ablation of atrial fibrillation (Cox-Maze
procedure). The latter involves isolating certain nerve junctions
responsible for uncontrolled movements of the heart muscle. This
isolation is achieved by producing necrosis of certain areas
extending along a line encircling the pulmonary veins and the
mitral valve. This operation is performed by locally burning the
tissues by passage of an electric current or by radiofrequency, or
even ultrasound or cryogenics. The electrical applications can be
unipolar or bipolar. The presence of a retractor such as the one
according to the invention represents-a priori an inconvenience
since its wall is interposed between the zones to be treated and
the tools necessary for producing the necrosis. It has therefore
been proposed to place on the actual wall of the retractor the
elements 42 needed for producing such necrosis, as is shown in FIG.
10.
[0054] The retractor function is thus combined with that of a
support for one or more electrodes 42 (or antennas, or even
cryogenic conduits) arranged in a suitable configuration (in this
case following the pathway of the lines of necrosis) and integrally
joined to the wall of the retractor. Once introduced into the
atrium, the retractor is positioned in such a way that the
electrode or electrodes 42 are arranged in line with the zones that
are to be treated (origin of the pulmonary veins 43 as shown in
FIG. 11) and the required energy is administered via these
electrodes or conduits 42 with the aid of an external generator,
which is known to a person skilled in the art and is connected to
the electrodes or to the conduit. Once this procedure has been
carried out, the retractor 6 is disconnected and repositioned, if
necessary, so as to fulfil strictly its role of retractor for the
second procedure (such as a mitral valve repair).
[0055] In practice, the electrodes 42 are formed from wires or
printed circuits coated with or embedded in a sheet of plastic
material from which connecting means 44 emerge. These electrodes 42
can also be supported by a sheet of adhesive material applied to
the retractor.
[0056] The different procedures involved in using the retractor 6
according to the invention can therefore be summarized as follows:
[0057] providing a plate of elastic material that is able to adopt
a substantially truncated cone shape; [0058] bringing said plate
into its truncated cone shape; [0059] gripping said plate via its
end of large diameter, which forms its proximal part, and rolling
it up in such a way as to form a cylinder of small diameter; [0060]
passing the retractor through the incision, with the distal part,
corresponding to its narrowest diameter, towards the front; [0061]
allowing the retractor to unroll in such a way that it readopts its
truncated cone shape.
[0062] It will be obvious to a person skilled in the art that the
present invention is not limited to what has been described above.
The invention lies also in each of the novel characteristics and in
the combination of these various characteristics.
* * * * *